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Talus is one of the bones of the foot that forms the lower part of the ankle joint. Its main function is transferring of body weight to the surface of the foot: scaphoid, calcaneus and cuboid bones. The talus can be divided into three parts: the body, the head and the neck. Talus is covered with a articular cartilage.

 

Aseptic necrosis (“avascular osteonecrosis”) is a severe degenerative joint disease that is accompanied by tissue necrosis. Such necrosis is also called ischemic because it occurs due to insufficient blood supply. And since necrosis occurs without the participation of microorganisms, the term “aseptic” is used. Focal bone infarction can be secondary or idiopathic, i.e. arising for an unknown reason. Most often, this pathology develops with a fracture of talus located between tibia and calcaneus bone of the foot.

Aseptic talus necrosis (fragment of detached cartilage)

Causes

In approximately 25% of patients, the cause of aseptic necrosis of talus cannot be precisely determined. Among the identified causes, there are:

  • alcohol abuse;
  • long-term use of certain hormonal drugs (Prednisone, Metipred, etc.);
  • various injuries of ankle joint;
  • often sudden changes in pressure (for example, for divers);
  • excessive loads on the joint (physical or overweight);
  • some types of medical procedures (chemotherapy, radiation therapy, dialysis, organ transplantation).

It has now been established that only a combination of several causes can provoke this disease. Chronic diseases such as diabetes, Gaucher disease, lupus, sickle cell anemia increase the risk of osteonecrosis. Necrosis can begin against the background of severe fatigue or nervous tension.

Stages of avascular necrosis of the talus

Symptoms of the disease

Pain, lameness, and over time, impaired joint function (limitation of movement) suggest the presence of osteonecrosis. The intensification of pain with aseptic necrosis occurs gradually, but most patients remember well when it first appeared.

 

Diagnostics

To diagnose aseptic necrosis and find out the stage of the disease, different methods are used:

  • Joint radiography;
  • CT scan;
  • MRI, etc.

But an X-ray examination in the early stages of osteonecrosis does not allow you to see any pathology. That is why magnetic resonance imaging or computed tomography are considered mandatory, which allow you to identify this disease at any stage with almost one hundred percent accuracy.

MRI and x-ray with aseptic necrosis of the talus

 

Treatment

Methods of treating aseptic necrosis are divided into conservative and surgical. With the help of conservative treatment, you can slow down the progression of the disease, it involves:

  • relieving pain and reducing inflammation by taking non-steroidal anti-inflammatory drugs and corticosteroids;
  • use of vasodilator drugs to eliminate stagnation of blood circulation and drugs that stimulate the restoration of bone tissue, as well as drugs for reperfusion of necrosis zone (iloprost);
  • prescription of physiotherapy exercises and massage to enhance the contractile function of muscles;
  • use of various physiotherapeutic procedures, shock wave therapy;
  • use of orthopaedic insoles for the normal distribution of load on the foot.

Unfortunately, it is impossible to stop the development of osteonecrosis, even detected at the earliest stages. Today, there are no drugs and medical devices that can positively affect the course of the disease. Surgery is the only way to significantly alleviate the condition of the patient.

When talus is damaged, the following types of operations are performed:

  • Chondroplasty (replacing the affected area with a fragment taken from the femur or with artificial materials).
  • Tunneling (drilling of the affected area).
  • In advanced cases, an operation to remove talus can be performed.
    • The decision about which operation is necessary is made by the attending physician with the consent of the patient.

      It is important not to endure the pain and hope that it will pass, but to consult a doctor on time. And then it will be possible to quickly restore joint function.